Experts charge that the federal government is trampling on seniors' rights to opt out of Medicare by making such a move too expensive. According to the Social Security Administration's Operation Manual, seniors cannot opt out of Medicare's Hospital Insurance (Part A) if they receive any Social Security benefits -- even if there is a recognized religious or philosophical reason for doing so -- unless they repay all benefits from both Social Security and Medicare Part A.

• In 1960, the Supreme Court ruled that people don't have a constitutional right to such benefits.

• Thus, the only way to get out of Part A is to forgo all Social Security and Medicare benefits by not signing up from the onset -- even though workers have paid for them through payroll deductions all their working lives.

• Doctors may not treat Medicare-eligible seniors outside the system unless they agree not to provide any Medicare services for two years.

Medicare’s Supplemental Medical Insurance (Part B) is voluntary in the sense that individuals can decline coverage when they retire, and it is funded partly through monthly premiums paid by seniors and general revenues, rather than payroll tax deductions.

The restrictions make it virtually impossible for seniors to avoid Medicare if they want access to health care. In April, the U.S. District Court for the District of Columbia ruled that the Constitution does not "confer a fundamental right on individuals to privately contract with their physicians."

Source: Naomi Lopez (Pacific Research Institute), "Medicare or No Care," Investor's Business Daily, October 8, 1998.